All workers’ compensation claims management teams should have an attitude that seeks best in class when it comes to claims management practices. This includes a focus on injury prevention, investigation and seeking to settle cases in a timely manner. By taking proactive steps in these areas, any claims team will be set up for success and improve processes for employers and employees suffering from work-related injuries. It will also reduce costs in the long run.
Start with Injury Prevention and Investigation
Injury prevention and investigation requires members of the claims management team to be proactive. This includes creating partnerships with their clients on all workplace safety matters. They also must be involved on the investigation of an injury and to ensure the correct reports are made in a timely manner.
- Safety Recommendations: Members of the claims management team must be able to identify safety hazards and make recommendations regarding workplace safety. This includes a review of safety equipment being used in the workplace. Examples of this can include a review of workplace ergonomics and the rotation of job duties in repetitive lines of work or those that require heavy lifting. It can also include the use of forensic experts who can dissect the anatomy of an injury and suggest improvements. Injury avoidance measures also promotes employee satisfaction and positive morale within any company.
- Primary Liability Determination: Time is of the essence when it comes to the investigation of any injury. Claim handlers must be proactive on this issue to encourage their clients to obtain an injury report immediately and assist in the identification and follow-up with witnesses. It is also important to understand and correctly apply the law. Failure to make accurate primary liability determinations is an unnecessary cost and increases work for all interested stakeholders.
- OSHA and Other Safety Compliance: Compliance with government and industry safety standards is an important component of any workers’ compensation program. Claim handlers can help educate their clients on the basics of OSHA reporting. This also includes information on state safety organizations tasked with injury investigations. Failure to report any work injury in a timely manner can result in fines and other adverse consequences.
Promotion of Settlement Practices
The only good file is a closed file! This is the mantra used throughout the claims management industry.
If a case is investigated and handled properly, it can be positioned for timely resolution. Failing to do so can result in extra costs to any workers’ compensation program. There are other additional considerations to be mindful of to save a program money and earn the respect of employer stakeholders.
- Subrogation: This is the practice of seeking reimbursement from another party who shares in the legal responsibility for a work injury. In order for any subrogation action to be successful, it is important to preserve physical evidence. Common instances where subrogation recovery comes into play includes products liability actions, motor vehicle accidents and premise liability claims (slips/falls). Examples of this can include a power tool or piece of machinery in a work injury. Photographs of surface conditions or accident scenes are other forms of evidence that required for successful third-party recovery.
- Independent Medical Examinations: In many jurisdictions, the defense interests have one opportunity to have an injured employee be seen for purposes of an IME. Failure to prepare for this by recovering the necessary medical documents and obtaining other background information on the claim can result in a waste of time and money.
- Medicare Secondary Payer Compliance: This is an area that continues to dominate workers’ compensation claims management given the increasing number of Americans on Medicare and/or Social Security Disability. Part of any effective workers’ compensation program includes working with legal experts or other service providers who understand these complex issues.
- Structured Settlement: Structured settlements are a stream of tax-free (IRC 104(a)(2) of (a)(3)) secure periodic payments providing income to an injured worker to settle a workers’ compensation claim. In addition to providing income for an injured worker, a structured settlement can provide income and up-front cash for attorney fees, medical expenses, and related liens. A structured settlement is a valuable piece of a comprehensive claim settlement strategy and creates a ‘win’ for all parties to a workers’ compensation settlement; the employer, the payer, the injured worker, and the attorneys
Claims management teams need to focus on high standards when it comes to assisting employers and other interested stakeholders in workers’ compensation claims. Best-in-class should be the goal when developing a workers’ comp management program. This starts with proactive injury prevention and investigation, as well as a firm understanding of settlement tools.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .
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